Approved by Council, October 26, 2002
Revised and approved by Council, June 21, 2003To be reviewed

The American Academy of Child and Adolescent Psychiatry (AACAP), which represents over 6,700 child and adolescent psychiatrists, opposes arbitrary limits on time or number of sessions for the initial psychiatric diagnostic evaluation. The insurance industry, managed care companies, and health administrators must adopt reasonable and clinically appropriate policies and guidelines regarding the psychiatric diagnostic evaluation of children and adolescents. Moreover, states and the Federal government must assure appropriate access to psychiatric evaluation for all children and adolescents.

The psychiatric assessment of the child differs from that of the adult in several important respects. Such evaluations require examination of the current problem with attention to developmental, behavioral, emotional, cognitive, educational, biomedical, family, peer, and social components. A thorough history of both the child and the family, including a comprehensive review of systems and a child mental status exam is a necessity.

A comprehensive psychiatric evaluation usually requires several hours to complete and is often best performed over several sessions, including sessions for the child and parents separately and together. In addition, a full evaluation usually requires the collection of information from a variety of outside sources, such as the school, child's pediatrician, psychological testing, and social service agencies. By contrast, many managed care companies currently are authorizing only a single diagnostic session. Such restrictions are inadequate and may lead to insufficient information, condensed evaluations, diagnostic errors, and inadequate treatment planning. The child and adolescent psychiatrist is responsible for exercising clinical judgment regarding the time and procedures necessary to complete a thorough evaluation.